明代助产手法的进步及其评价

明代的助产手法比北宋杨子建《十产论》的内容有了进一步的发展,表现在各种妇产医著对之有比较广泛的记载,疗效也得到医家们比较普遍的承认。更重要的是手法操作过程得到改进,如提出作好术前的准备工作,剪除指甲、香油润手。而且必须对胎儿位置确诊无疑,严格掌握各种手法的适应症,并增加了胎盘剥离手法及碎胎术。这是明代中医产科学中很值得重视的一部分。虽然仍有许多缺陷,但在当时的医疗条件下,不失为一种有效的急救措施。     

川东北地区剖宫产再孕妇女分娩方式的选择对 助产士岗位需求影响的研究

目的 研究川东北地区剖宫产再孕妇女分娩方式的选择对助产士资源配置的影响。方法 对各市、县部分医疗机构负责人及妇产科主任、助产士进行定性访谈,搜集本地区2017年1月~12月卫生统计数据进行统计分析,对2017年1月~12月川东北地区剖宫产再孕妇女分娩方式的选择进行针对性问卷调查。结果 2016年“全面二孩”政策后,2017年再生育孕妇建册量占所有孕妇建册量的38.61%~41.23%,剖宫产再孕孕妇占再生育孕妇的37.80%~48.31%,三级医疗保健机构助产士∶医院产床比约为2.8∶1,助产士全部毕业于助产专业,老中青各级助产人员比为1∶3∶2,学历本科占80.03%,大专19.97%;二级及其他医疗保健机构助产士∶产床比约为2.1∶1,毕业于助产专业的占48.42%,从临床护士转助产士的占51.58%,45.57%的医疗保健机构在二孩政策放开后,才开始按助产士∶产床3∶1的比例培养助产士,58.70%的培养对象是临床护士转助产士。2017年三甲综合医院剖宫产再孕孕妇阴道分娩占顺产率的5.32%~9.42%,其他医疗保健机构剖宫产再孕孕妇阴道分娩占顺产率的0.81%~1.34%。结论 要提高川东北地区剖宫产再孕妇女阴道自然分娩率,各助产机构不仅应配备足够数量的助产士,而且要不断提高助产士的核心胜任力。     

Midwives Roles in Women’s Improvement of Protective Behaviour against Breast Cancer Whether they have a Family History of Cancer or Not

Purpose: The aim of the study was to determine roles of midwives in helping women improve behavior for protection against breast cancer and towards early diagnosis whether they have a family history of cancer or not. Materials and methods: The study was planned in order to evaluate the efficacy of education about the risk factors of breast cancer and primary and secondary protection (early diagnosis) measures given to the women between the ages of 20-49, literate, married and who had or did not have cancer cases in their families. It was carried out in the region of Çamkule Levent Kara Health Care Center between March 2006 and April 2007. Results: Age, educational and economic status of the women with or without a cancer case in their families have been equivalent and a statistically significant difference has not been determined between both of the groups (p>0.05). The cancer risk perception of the women having a cancer case in their families (75.8%) was higher than in those wwithout (62.8%) (p<0.005). Although they were also better informed about protection against cancer and early diagnosis, they do not participate to a greater extent in the practices of early diagnosis-scanning of breast cancer and they do not turn the information into attitude or behavior. Conclusion: The results of the study showed that midwives have significant responsibilities for directing all women towards protection against breast cancer and early diagnosis programs.     

盐城市助产士职业压力现状及相关因素调查

目的:了解盐城市助产士职业压力现状及其相关因素,为护理管理者提供依据.方法:选取盐城市三级医院和二级医院的所有在职助产士,应用一般资料调查问卷和护士职业压力量表进行调查.结果:助产士职业压力总平均分为(3.45±1.04)分,各维度得分为:职业特点引起的压力维度3.86±1.12分,护理管理引起的压力维度3.21 ±1.25分,病人及家属带来的压力维度3.47±1.23分,人力资源造成的压力维度3.45士1.29分,社会地位及待遇引起的压力维度3.84±1.19分,角色适应引起的压力维度2.81±1.34分.二级医院助产士职业压力高于三级医院助产士.与助产士职业压力相关的因素包括有无其他工作经验、职称、婚姻及生育状况、单位等级.结论:盐城市助产士职业压力处于中等偏上水平,管理者可根据影响助产士职业压力的相关因素,采取相应的策略,降低其压力,稳定助产人才队伍,提高母婴服务质量.     

Making physiological birth possible: Birth at a free-standing birth centre in Berlin

Background

the practical training in midwifery education in Germany takes place predominantly in hospital delivery wards, where high rates of intervention and caesarean section prevail. When midwives practice birth assistance at free-standing birth centres, they have to make adjustments to what they learned in the clinic to support women without the interventions common to hospital birth.

Objectives

the primary aim of this study was to investigate and describe the approach of midwives practicing birth assistance at a free-standing birth centre.

Methodology

a qualitative approach to data collection and analysis with grounded theory was used which included semi-structured expert interviews and participant observation. Five midwives were interviewed and nine births observed in the research period. The setting was a free-standing birth centre in a large German city with approximately 115 births per year.

Findings

the midwives all had to re-learn birth assistance when commencing work outside of the hospital. However, having been trained predominantly in hospital maternity wards, they have retained many aspects characteristic of their training. The midwives use technology, although minimal, and medical discourse in combination with 1:1, woman-centred care. The birthing woman and midwife share authority at birth. The fetus is treated as an ally of the mother, suited for birth and cooperative. Through use of objective and subjective criteria, the midwives have their own approach to making physiological birth possible.

Key conclusions and implications for practice

to prepare midwives to support low-intervention birth, it is necessary to include training in birth assistance with women who birth physiologically, without interventions common to hospital birth. The results of this study would also suggest that the rate of interventions in hospital could be reduced if midwives gain more experience with women birthing without the above-mentioned interventions.     

孕产期分级保健照护方案的构建与应用研究

目的 探讨孕产期分级保健照护方案对提高母婴保健服务质量及改善妊娠结局的作用。方法 基于信息平台建设,通过医联体内区域协作,构建孕产期分级保健照护方案。选取在我院医联体内社区医院建档的312名孕产妇作为研究对象,随机分为试验组和对照组,试验组实施信息化孕产期分级照护方案的保健服务,对照组实施基础孕产期保健服务,收集相关指标并进行分析比较。结果 试验组助产士保健服务覆盖率、孕早中期助产士保健服务覆盖率、孕产期保健知识平均得分、自然分娩率、6个月内纯母乳喂养率、孕期体重增长达标率以及孕产妇对保健服务的满意度均高于对照组（P<0.05）;试验组孕产妇失访率、妊娠期糖尿病及妊娠合并贫血的发生率低于对照组（P<0.05）。结论 孕产期分级保健照护方案可有效提高孕产期保健服务质量,促进自然分娩及母乳喂养,减少不良妊娠结局的发生。     

助产士一对一全程陪伴联合配偶产程支持干预在单胎足月初产妇经阴道分娩过程中的应用效果分析

目的 探讨助产士一对一全程陪伴联合配偶产程支持干预在单胎足月初产妇经阴道分娩过程中的应用效果.方法 选取单胎足月初产妇183例,均经阴道分娩,根据护理干预方法的不同分为对照组(n=88)和观察组(n=95).对照组接受常规分娩护理干预,观察组在对照组基础上接受助产士一对一全程陪伴联合配偶产程支持干预,比较两组干预前后的...     

Midwives’ perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review

Backgroundperinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period.Aimto synthesise primary research on midwives’ perceived role in Perinatal Mental Health (PMH).Designintegrative review.MethodsWhittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted.Findingsa total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support.Conclusions and implications for practicethe findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit.     

Global challenges in health and health care for nurses and midwives everywhere

The next decade is likely to produce any number of global challenges that will affect health and health care, including pan-national infections such as the new coronavirus COVID-19 and others that will be related to global warming. Nurses will be required to react to these events, even though they will also be affected as ordinary citizens. The future resilience of healthcare services will depend on having sufficient numbers of nurses who are adequately resourced to face the coming challenges.     

The lady with the lamp: Amid the COVID-19 haze

The COVID-19 pandemic is currently the dominant public health topic across every nation. The world of health care is shrouded in the haze of the COVID-19 pandemic and is experiencing unprecedented patient loads arising from this complicated and unfamiliar viral disease. No one was prepared for this. Unsurprisingly, there are shortages of supplies and equipment, treatment space and people with the skills to respond to the containment, treatment and prevention of COVID-19. Nurses are at the front line of every nation’s response, trying to provide assessment, protection, treatment and prevention as being part of the overwhelming care demand that is occurring. Across every nation, the ongoing policy implications of the pandemic should be considered, as well as for those pandemics in the future. This includes, but is not limited to, investing in emergency systems and nurses, health research, and preparing for, managing and researching nursing practice.